Question 1

All of the following terms refer to analgesic drugs that affect the central nervous system except one. Which one is the exception?

Accepted Answer

A) Opioids
 B) Opiates
 C) Narcotics
** D) Nonsteroidal antiinflammatory drug (NSAIDs)

Question 2

Opioids are classified according to their chemical structure. Agents with similar chemical structures are most likely to be cross-allergenic.

Accepted Answer

A) Both statements are true.

Question 3

Which of the following opioids is considered the prototype (i.e., drug against which all other opioids are measured)?

Accepted Answer

Morphine

Question 4

All of the following are pharmacologic actions of opioids except one. Which one is the exception?

Accepted Answer

) Excitation

Question 5

The adverse reactions of the opioids are directly related to damage to hepatic, renal, and hematologic tissues. The adverse effects of the opioids are extensions of their pharmacologic effects, which is proportional to their analgesic strength.

Accepted Answer

) The first statement is false; the second statement is true.

Question 6

The usual cause of death in opioid overdose is:

Accepted Answer

Depression of respiration

Question 7

Opioids mimic the action of which of the following endogenous substances by binding to these naturally occurring receptor sites?

Accepted Answer

) Enkephalins, endorphins, and dynorphins

Question 8

Patients who are given analgesic doses of opioids frequently suffer from nausea and vomiting caused by the stimulation of the chemoreceptor trigger zone in the brain. Reducing this adverse effect can be achieved by:

Accepted Answer

) Discouraging movement or ambulation

Question 9

Naloxone is an example of a(an):

Accepted Answer

Opioid antagonist

Question 10

What effect does opioid use have the fetus of a pregnant mother near term?

Accepted Answer

Fetal respiratory depression and withdrawal symptoms

Question 11

Which of the following routes of administration will result in a reduction in systemic distribution of opioids?

Accepted Answer

Oral

Question 12

Tolerance does not develop to which of the following effects of opioids?

Accepted Answer

Myosis and constipation

Question 13

Which of the following factors determines the addiction potential of opioids?

Accepted Answer

Potency of the analgesic and frequency of use

Question 14

“Shoppers” are addicts who try to use dentists or physicians who will prescribe their drug of choice. Shoppers are usually willing to try any opioid or controlled substance the physician is willing to provide.

Accepted Answer

The first statement is true; the second statement is false.

Question 15

The largest group of opioids is the:

Accepted Answer

) Morphine/codeine group

Question 16

Differences in action of different opioids in tolerance to pain may be the result of variations in the endogenous levels of the neurotransmitters.

Accepted Answer

TRUE

Question 17

Differences in the action of different opioids at these and other specific receptors explain some of the variations among the different opioids' adverse reactions.

Accepted Answer

TRUE

Question 18

Which of the following statements are correct concerning opioid receptors?

Accepted Answer

A) Stimulation of μ-receptors produces analgesia.
 B) The κ-receptor is responsible for dysphoria.
 C) Naloxone is an antagonist at the three receptor sites.
 D) Morphine has no effect on the κ-receptor.
** E) All of the above
 F) a, b, and c only

Question 19

Which of the following routes of absorption can be used with opioids?

Accepted Answer

A) Oral
 B) Absorbed through the mucous membranes of mouth, nose, and lungs
 C) Transdermal patches
 D) Parenteral
 E) All of the above

Question 20

The major route of metabolism for the opioids is the:

Accepted Answer

Liver

Question 21

Codeine has all of the following effects in usual therapeutic doses except one. Which one is the exception?

Accepted Answer

A) Pain threshold increase, pain reaction reduction
 B) Sedation and euphoria
 C) Cough suppression
 **D) Central nervous system excitation
 E) Decreases propulsive contractions and motility of intestinal tract

Question 22

Which of the following statements is correct concerning depression of the respiratory center by opioids?

Accepted Answer

A) Respiratory depression is dose related.
 B) Opioids decrease the sensitivity of the brainstem to carbon dioxide.
 C) Opioids decrease the rate and depth of breathing.
 D) In elderly adults or debilitated persons, the usual therapeutic dose can caus

Question 23

Patients with which of the following conditions are least sensitive to the respiratory depression induced by opioids?

Accepted Answer

Hyperthyroidism

Question 24

Nausea and vomiting with analgesic doses of opioids is caused by:

Accepted Answer

A) Direct stimulation of chemoreceptor trigger zone in the medulla
 B) Indirect stimulation of the vestibulocochlear area
 C) Patient movement
 D) All of the above
** E) a and c only

Question 25

Small doses of even weak opioids often cause constipation. With continued administration, tolerance will develop to this effect

Accepted Answer

The first statement is true; the second statement is false.

Question 26

Opioid abuse or overdose can often by diagnosed by which of the following signs?

Accepted Answer

Myosis (pinpoint pupils)

Question 27

Large doses of the opioids have which of the following effects on the cardiovascular system?

Accepted Answer

A) Postural hypotension, syncope
 B) Depression of the vagus nerve
 C) Stimulation of vagus nerve
 D) Bradycardia
 E) a, b, and d
 **F) a, c, and d

Question 28

Why would a patient who is taking opioids develop a runny nose and itchy eyes?

Accepted Answer

Histamine release stimulated by opioids

Question 29

The rate of development of tolerance and addiction is related to the strength of the opioid and its frequency and length of use. Addiction to opioid analgesics is a common problem when they are used to treat dental-related pain.

Accepted Answer

The first statement is true; the second statement is false.

Question 30

Opioid withdrawal includes all of the following signs and symptoms except one. Which one is the exception?

Accepted Answer

A) Yawning, lacrimation, perspiration, and rhinorrhea
 B) Piloerection
 **C) Drowsiness
 D) Irritability
 E) Nausea and vomiting
 F) Tachycardia
 G) Tremors and chills

Question 31

Which opioid is frequently used to help patients discontinue opioid use and is used both short term and long term for maintenance?

Accepted Answer

Methadone

Question 32

Opioids should be used with caution with other central nervous system depressants. The respiratory depression produced by the opioids is additive with that produced by other central nervous system depressants.

Accepted Answer

Both true

Question 33

Your patient states that he is allergic to morphine. Which other opioid would be safe to administer to this patient?

Accepted Answer

Meperidine

Question 34

The most commonly used opioid in dentistry is:

Accepted Answer

Codeine

Question 35

Tylenol #3 would have how much codeine added to the acetaminophen?

Accepted Answer

30 mg
The amount of codeine in combination products is designated by Arabic numbers. #2 = 15 mg of codeine, #3 = 30 mg of codeine, and #4 = 60 mg of codeine.

Question 36

All of the following statements are true regarding propoxyphene (Darvocet) except one. Which one is the exception?

Accepted Answer

E) Propoxyphene is so effective that justifying a prescription of propoxyphene is easy.

Question 37

Meperidine (Demerol) is a good choice for oral use because it has a long duration of action and few drug interactions.

Accepted Answer

Both parts of the statement are false.

Question 38

Which of the following statements is correct regarding the opioid hydromorphone (Dilaudid)?

Accepted Answer

A) Only administered parenterally
 B) Reserved for management of severe pain
 C) Less potent than morphine
 D) Favored by addicts because of its strength
 E) All of the above
 **F) b and d only

Question 39

Methadone (Dolophine) has all of the following advantages over morphine or hydrocodone except one. Which one is the exception?

Accepted Answer

A) Longer duration of action, easier withdrawal from drug
 B) Good bioavailability
 C) Cost effect
 D) Oral rather than parenteral route of administration
 E) Great risk for death and life-threatening changes in respiration and heart rate

Question 40

Which of the following opioid family is most commonly used perioperative or during general anesthesia?

Accepted Answer

Fentanyl family

Question 41

Naloxone (Narcan) is an opioid antagonist that is active parenterally. If given to an addict who has overdosed, large doses must be given to counteract the opioid-induced respiratory depression.

Accepted Answer

) The first statement is true; the second statement is false.

Question	Answer
All of the following terms refer to analgesic drugs that affect the central nervous system except one. Which one is the exception?	A) Opioids B) Opiates C) Narcotics ** D) Nonsteroidal antiinflammatory drug (NSAIDs)
Opioids are classified according to their chemical structure. Agents with similar chemical structures are most likely to be cross-allergenic.	A) Both statements are true.
Which of the following opioids is considered the prototype (i.e., drug against which all other opioids are measured)?	Morphine
All of the following are pharmacologic actions of opioids except one. Which one is the exception?	) Excitation
The adverse reactions of the opioids are directly related to damage to hepatic, renal, and hematologic tissues. The adverse effects of the opioids are extensions of their pharmacologic effects, which is proportional to their analgesic strength.	) The first statement is false; the second statement is true.
The usual cause of death in opioid overdose is:	Depression of respiration
Opioids mimic the action of which of the following endogenous substances by binding to these naturally occurring receptor sites?	) Enkephalins, endorphins, and dynorphins
Patients who are given analgesic doses of opioids frequently suffer from nausea and vomiting caused by the stimulation of the chemoreceptor trigger zone in the brain. Reducing this adverse effect can be achieved by:	) Discouraging movement or ambulation
Naloxone is an example of a(an):	Opioid antagonist
What effect does opioid use have the fetus of a pregnant mother near term?	Fetal respiratory depression and withdrawal symptoms
Which of the following routes of administration will result in a reduction in systemic distribution of opioids?	Oral
Tolerance does not develop to which of the following effects of opioids?	Myosis and constipation
Which of the following factors determines the addiction potential of opioids?	Potency of the analgesic and frequency of use
“Shoppers” are addicts who try to use dentists or physicians who will prescribe their drug of choice. Shoppers are usually willing to try any opioid or controlled substance the physician is willing to provide.	The first statement is true; the second statement is false.
The largest group of opioids is the:	) Morphine/codeine group
Differences in action of different opioids in tolerance to pain may be the result of variations in the endogenous levels of the neurotransmitters.	TRUE
Differences in the action of different opioids at these and other specific receptors explain some of the variations among the different opioids' adverse reactions.	TRUE
Which of the following statements are correct concerning opioid receptors?	A) Stimulation of μ-receptors produces analgesia. B) The κ-receptor is responsible for dysphoria. C) Naloxone is an antagonist at the three receptor sites. D) Morphine has no effect on the κ-receptor. ** E) All of the above F) a, b, and c only
Which of the following routes of absorption can be used with opioids?	A) Oral B) Absorbed through the mucous membranes of mouth, nose, and lungs C) Transdermal patches D) Parenteral E) All of the above
The major route of metabolism for the opioids is the:	Liver
Codeine has all of the following effects in usual therapeutic doses except one. Which one is the exception?	A) Pain threshold increase, pain reaction reduction B) Sedation and euphoria C) Cough suppression **D) Central nervous system excitation E) Decreases propulsive contractions and motility of intestinal tract
Which of the following statements is correct concerning depression of the respiratory center by opioids?	A) Respiratory depression is dose related. B) Opioids decrease the sensitivity of the brainstem to carbon dioxide. C) Opioids decrease the rate and depth of breathing. D) In elderly adults or debilitated persons, the usual therapeutic dose can caus
Patients with which of the following conditions are least sensitive to the respiratory depression induced by opioids?	Hyperthyroidism
Nausea and vomiting with analgesic doses of opioids is caused by:	A) Direct stimulation of chemoreceptor trigger zone in the medulla B) Indirect stimulation of the vestibulocochlear area C) Patient movement D) All of the above ** E) a and c only
Small doses of even weak opioids often cause constipation. With continued administration, tolerance will develop to this effect	The first statement is true; the second statement is false.
Opioid abuse or overdose can often by diagnosed by which of the following signs?	Myosis (pinpoint pupils)
Large doses of the opioids have which of the following effects on the cardiovascular system?	A) Postural hypotension, syncope B) Depression of the vagus nerve C) Stimulation of vagus nerve D) Bradycardia E) a, b, and d **F) a, c, and d
Why would a patient who is taking opioids develop a runny nose and itchy eyes?	Histamine release stimulated by opioids
The rate of development of tolerance and addiction is related to the strength of the opioid and its frequency and length of use. Addiction to opioid analgesics is a common problem when they are used to treat dental-related pain.	The first statement is true; the second statement is false.
Opioid withdrawal includes all of the following signs and symptoms except one. Which one is the exception?	A) Yawning, lacrimation, perspiration, and rhinorrhea B) Piloerection **C) Drowsiness D) Irritability E) Nausea and vomiting F) Tachycardia G) Tremors and chills
Which opioid is frequently used to help patients discontinue opioid use and is used both short term and long term for maintenance?	Methadone
Opioids should be used with caution with other central nervous system depressants. The respiratory depression produced by the opioids is additive with that produced by other central nervous system depressants.	Both true
Your patient states that he is allergic to morphine. Which other opioid would be safe to administer to this patient?	Meperidine
The most commonly used opioid in dentistry is:	Codeine
Tylenol #3 would have how much codeine added to the acetaminophen?	30 mg The amount of codeine in combination products is designated by Arabic numbers. #2 = 15 mg of codeine, #3 = 30 mg of codeine, and #4 = 60 mg of codeine.
All of the following statements are true regarding propoxyphene (Darvocet) except one. Which one is the exception?	E) Propoxyphene is so effective that justifying a prescription of propoxyphene is easy.
Meperidine (Demerol) is a good choice for oral use because it has a long duration of action and few drug interactions.	Both parts of the statement are false.
Which of the following statements is correct regarding the opioid hydromorphone (Dilaudid)?	A) Only administered parenterally B) Reserved for management of severe pain C) Less potent than morphine D) Favored by addicts because of its strength E) All of the above **F) b and d only
Methadone (Dolophine) has all of the following advantages over morphine or hydrocodone except one. Which one is the exception?	A) Longer duration of action, easier withdrawal from drug B) Good bioavailability C) Cost effect D) Oral rather than parenteral route of administration E) Great risk for death and life-threatening changes in respiration and heart rate
Which of the following opioid family is most commonly used perioperative or during general anesthesia?	Fentanyl family
Naloxone (Narcan) is an opioid antagonist that is active parenterally. If given to an addict who has overdosed, large doses must be given to counteract the opioid-induced respiratory depression.	) The first statement is true; the second statement is false.

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Pharm Chapter 6